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Nutrition Standards for Foods in Schools: Leading the Way Toward Healthier Youth.
Washington, DC: The National Academies Press, 2007.

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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the
Governing Board of the National Research Council, whose members are drawn
from the councils of the National Academy of Sciences, the National Academy
of Engineering, and the Institute of Medicine. The members of the committee
responsible for the report were chosen for their special competences and with
regard for appropriate balance.
This study was supported by grant number H75/CCH324857-01 between the
National Academy of Sciences and the Centers for Disease Control and Preven-
tion. Any opinions, findings, conclusions, or recommendations expressed in this
publication are those of the authors and do not necessarily reflect the views of
the sponsoring agency that provided support for the project.
Library of Congress Cataloging-in-Publication Data
Nutrition standards for foods in schools : leading the way toward
healthier youth / Committee on Nutrition Standards for Foods in Schools,
Food and Nutrition Board ; Virginia A. Stallings and Ann L. Yaktine,
editors.
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-0-309-10383-1 (hardbound : alk. paper)
ISBN-10: 0-309-10383-5 (hardbound : alk. paper) 1. School
children—Nutrition—Government policy—United States. 2. School
lunchrooms, cafeterias, etc.—Management—United States. 3. Nutrition
policy—United States. I. Stallings, Virginia A. II. Yaktine, Ann L.
III. Institute of Medicine (U.S.). Committee on Nutrition Standards for
Foods in Schools.
LB3479.U6N88 2007
371.7´160973—dc22
2007023350
Additional copies of this report are available from the National Academies
Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800)
624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet,
http://www.nap.edu.
For more information about the Institute of Medicine, visit the IOM home page
at: www.iom.edu.
Copyright 2007 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America.
The serpent has been a symbol of long life, healing, and knowledge among
almost all cultures and religions since the beginning of recorded history. The
serpent adopted as a logotype by the Institute of Medicine is a relief carving
from ancient Greece, now held by the Staatliche Museen in Berlin.
Suggested citation: IOM (Institute of Medicine). 2007. Nutrition Standards for
Foods in Schools: Leading the Way Toward Healthier Youth. Washington, DC:
The National Academies Press.

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“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
—Goethe
Advising the Nation. Improving Health.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society
of distinguished scholars engaged in scientific and engineering research, dedicated to
the furtherance of science and technology and to their use for the general welfare.
Upon the authority of the charter granted to it by the Congress in 1863, the Acad-
emy has a mandate that requires it to advise the federal government on scientific
and technical matters. Dr. Ralph Cicerone is president of the National Academy of
Sciences.
The National Academy of Engineering was established in 1964, under the charter
of the National Academy of Sciences, as a parallel organization of outstanding en-
gineers. It is autonomous in its administration and in the selection of its members,
sharing with the National Academy of Sciences the responsibility for advising the
federal government. The National Academy of Engineering also sponsors engineer-
ing programs aimed at meeting national needs, encourages education and research,
and recognizes the superior achievements of engineers. Dr. Charles M. Vest is presi-
dent of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of
Sciences to secure the services of eminent members of appropriate professions in
the examination of policy matters pertaining to the health of the public. The Insti-
tute acts under the responsibility given to the National Academy of Sciences by its
congressional charter to be an adviser to the federal government and, upon its own
initiative, to identify issues of medical care, research, and education. Dr. Harvey V.
Fineberg is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sci-
ences in 1916 to associate the broad community of science and technology with the
Academy’s purposes of furthering knowledge and advising the federal government.
Functioning in accordance with general policies determined by the Academy, the
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of Sciences and the National Academy of Engineering in providing services to
the government, the public, and the scientific and engineering communities. The
Council is administered jointly by both Academies and the Institute of Medicine.
Dr. Ralph Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively,
of the National Research Council.
www.national-academies.org

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Reviewers
This report has been reviewed in draft form by individuals chosen for
their diverse perspectives and technical expertise, in accordance with pro-
cedures approved by the NRC’s Report Review Committee. The purpose
of this independent review is to provide candid and critical comments that
will assist the institution in making its published report as sound as possible
and to ensure that the report meets institutional standards for objectivity,
evidence, and responsiveness to the study charge. The review comments
and draft manuscript remain confidential to protect the integrity of the
deliberative process. We wish to thank the following individuals for their
review of this report:
Dorothy R. Caldwell, School Health Consultant, Raleigh, North Carolina
Susan Crockett, General Mills, James Ford Bell Technical Center
Barbara Devaney, Human Services Research, Mathematica Policy
Research
Adam Drewnowski, Center for Public Health Nutrition, Professor of
Epidemiology and Medicine, University of Washington
Deanna Hoelscher, School of Public Health, University of Texas Health
Science Center, Houston
Francine R. Kaufman, The Keck School of Medicine, University of
Southern California, Center of Endocrinology, Diabetes and
Metabolism, Children’s Hospital, Los Angeles
Ronald E. Kleinman, Pediatric Gastroenterology and Nutrition Unit,
Massachusetts General Hospital, Boston
ii

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iii REVIEWERS
Michael I. McBurney, Department of Nutrition and Food Science, Texas
Agricultural Experiment Station, Texas Cooperative Extension, Texas
A&M University
Theresa A. Nicklas, Baylor College of Medicine
Connie M. Weaver, Department of Foods and Nutrition, Purdue
University
Margo G. Wootan, Nutrition Policy, Center for Science in the Public
Interest
Although the reviewers listed above have provided many constructive
comments and suggestions, they were not asked to endorse the conclusions
or recommendations nor did they see the final draft of the report before its
release. The review of this report was overseen by Johanna T. Dwyer, Tufts
University School of Medicine and Tufts–New England Medical Center and
Neal A. Vanselow, Tulane University, Professor Emeritus. Appointed by the
National Research Council and Institute of Medicine, they were responsible
for making certain that an independent examination of this report was
carried out in accordance with institutional procedures and that all review
comments were carefully considered. Responsibility for the final content of
this report rests entirely with the authoring committee and the institution.

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Preface
My memories of food at school are many, starting with cafeteria lunch
provided after we presented our green lunch token and without discus-
sion of choices or options. Everyone had a lunch token, so no one knew
that there was a free or reduced-price lunch and no one went off campus
for lunch unless you lived in the neighborhood. Bigger or maybe hungrier
students got larger portions. A few students brought lunch in cool lunch
boxes, and we envied what was assumed to be a better lunch. There were
no vending machines until high school, and then the beverages were milk
(full-fat chocolate and regular), orange juice, and a few candy and cracker
snacks. I think the only soda machine was in the gym lobby.
Hallway or homeroom bake sales provided great homemade cookies,
cupcakes, fudge, and brownies. I recall that the school band had the rights
to the chocolate bar sale, complete with our school colors and mascot on
the label. Birthdays were not celebrated in school. The Halloween carnival
was all about food, fun, and homeroom pride for all, from first graders to
seniors. Dedicated parents and friends were the band and sport team boost-
ers, and loyally staffed the concession stand for the football and basketball
games. I don’t remember many students taking time from the action of the
game to eat, and we did not want to spend our allowance on food.
This was a time when childhood nutrition issues were iron deficiency
and undernutrition, when few were concerned about fat or sugar in child-
hood diets, and when most meals were consumed at home or school. I
now know that some children were hungry and the school lunch was an
important source of food. Interestingly, the key stakeholders have not
ix

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x PREFACE
changed—the children, families, school administrators, teachers, nurses,
coaches, food service team, and food industry. The local and state school
authorities implement federal policy and make many food and health deci-
sions at their levels. In the background, nutritionists, health-care provid-
ers, and other child advocates influence both policy and implementation.
We now clearly recognize the importance of food and nutrient intake on
child health and on lifelong adult health. All stakeholders are concerned
about diet quality, emerging food and health habits, and maintaining a pat-
tern of healthy childhood growth. Today overweight children outnumber
undernourished children, and yet normal or overweight status does not
guarantee food security and a healthful diet for many children. Our inex-
pensive, abundant food supply, and innovative food industry provide highly
palatable foods and beverages for children. School foods and beverages,
once almost limited to school lunch, now often include many choices in
addition to the federally supported school breakfast and lunch programs.
The calories and nutrients consumed at school and school-related activities
are an important component of dietary intake of all school-age children.
Childhood obesity is often referred to as an epidemic in both the medical
and community settings.
It is within this scientific and social environment that our committee
established our guiding principles and made recommendations for competi-
tive foods and beverages provided outside of the federally funded school
programs. The goal is for schools to employ their unique, long-term rela-
tionship with children and their families to support child health and pro-
vide a healthful school eating environment. Our committee is a dedicated
group of remarkable people from diverse backgrounds and experiences. We
quickly recognized that this was not an easy task. Over nearly 2 years, we
learned and debated together, and developed this set of food and beverage
standards for competitive foods and beverages, if they are offered.
Sincere appreciation is extended to the many individuals and groups
who were instrumental in the development of this report. First and fore-
most, many thanks are due to the committee members, who volunteered
countless hours to the research, deliberations, and preparation of the re-
port. Their dedication to this project was outstanding and the basis of our
success.
Many individuals volunteered significant time and effort to address and
educate our committee members during the workshops and public meet-
ings. Workshop speakers included Richard Black, Karen Cullen, Robert
Eadie, Stanley Garnet, Harold Goldstein, Nancy Green, Hope Hale, Mary
Kay Harrison, Jay Hirschman, Mary McKenna, Clare Miller, Derek Miller,
Alicia Moag-Stahlberg, Susan Neely, John Perkins, Michael Rosenberger,
Barbara O. Schneeman, Jonathan Shenkin, Susan Waltman, Shirley Watkins,

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xi
PREFACE
Marilyn Wells, Melanie White, Kathy Wiemer, Gail Woodward-Lopez, and
Margo Wootan.
In addition, representatives from many entities provided oral testimony
to the committee during public meetings that were held on October 26,
2005, December 5, 2005, February 13, 2006, and April 21, 2006. They
represented the Action for Healthy Kids, Albert Einstein College of Medi-
cine, American Academy of Pediatrics, American Beverage Association,
American Dietetic Association, American Heart Association, Baylor College
of Medicine, Boston University, The California Center for Public Health
Advocacy, The Centers for Disease Control and Prevention, The Center for
Science in the Public Interest, Coca-Cola North America, ConAgra Foods,
Inc., The Food and Drug Administration, Food Products Association, Gen-
eral Mills Bell Institute of Health and Nutrition, Grocery Manufacturers
Association, International Dairy Foods Association, Irving Independent
School District, Kraft Foods Inc., Los Angeles Unified School District, The
National Association of State Boards of Education, National Dairy Council,
National Medical Association, PepsiCo, The Physician’s Committee for Re-
sponsible Medicine, School Nutrition Association, Schwan Food Company,
The Texas Department of Agriculture, University of California–Berkeley,
The United States Department of Agriculture, Westchester Coalition, and
the West Virginia Department of Education.
It is apparent that many organizations and individuals from a variety of
school and scientific backgrounds provided timely and essential support for
this project. Yet we would have never succeeded without the efforts, skills,
and grace that were provided in large measure by Janice Okita, Ph.D.,
R.D. (8/05–7/06) and Ann Yaktine, Ph.D. (7/06–8/07), our Senior Program
Officers and Study Directors for this project; Amin Akhlaghi, Research
Associate (09/05–10/06); Alice Vorosmarti, M.S.P.H., Research Associate;
Heather Del Valle, B.S., B.A., Senior Program Assistant; and Linda Meyers,
Ph.D., Food and Nutrition Board Director. Thanks also to Hilary Ray for
technical editing.
Last, as chair, I express my sincere appreciation to each member of
this committee for their extraordinary commitment to the project and the
wonderful opportunity to work with them on this important task for the
nutrition and school communities and for the school children whose health
and future we were asked to consider.
Virginia A. Stallings, Chair
Committee on Nutrition Standards
for Foods in Schools